Meeting Room Request Form 
The Municipal Building is a publicly owned accessible building with two meetings rooms which are available for use of Township Residents and Non-Profit, Non-Political Groups. The rental fee is $50.00 and includes the use of a meeting room, rest rooms, and parking facilities.

One of the Township Constables will meet you at your start and ending times to open the building for you. (All Township Personnel have ID.) The facilities will be inspected prior to your occupancy and departure. Any damages occurring during your use time will be the responsibility of your group and you will be invoiced for any needed cleaning or repairs

Date of Use: ________ Start time: _________ End Time:_______

Please circle room requested.

Council Room with Council Table and seating for approx. 40.

Conference Room with oval table and seating for approx. 8.

Number of individuals expected is ___________.

Name of Individual / Group requesting use of facilities as noted above.

____________________________________________________________________________

Contact Person for Group: __________________________________

Phone Number for Contact Person: ___________________________

Address of Contact Person: __________________________________

By signing below you are accepting responsibility for the use of a meeting room.

Signature of Individual / Contact Person: _________________________________________

* * * * * * * * * * * * * * * * * * * * *For Office Use Only * * * * * * * * * * * * * * * * * * * * *

Date Requested ___________________ Fee Paid ______________ Ck # _____________

Room use confirmed by _________________________________ on ____________________

Use written in Calendar Book ______________ Constable given copy of request __________________

* * * * * * * * * * * * * * * * *For Constable Use - (See back side for inspection checklist)* * * * * * * * * * * * * * * * * * * * *

Start Time _____________ Pre-Inspection _________ End Time ____________ Post-Inspection _________

Date ____________________ Constable’s Name _____________________ Initials ____________________

revised by cmtm on 12/14/05

 

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